Which drug is administered to treat acutely decompensated heart failure?

• A. Lisinopril
• B. Labetalol
• C. Nesiritide (Natrecor)
• D. Furosemide

Answer: (C)

In acutely decompensated heart failure, the goal is rapid relief of congestion by lowering filling pressures and reducing the workload on the heart. Nesiritide is a recombinant B-type natriuretic peptide that, when given by intravenous infusion, causes both venous and arterial dilation. This lowers preload and afterload quickly and promotes natriuresis and diuresis, which helps pull fluid out of the lungs and improves breathing and oxygenation in the acute setting. Because it directly targets the hemodynamic derangements of acute decompensation, it’s particularly effective for rapid symptomatic relief in patients with significant pulmonary edema.

Other drugs listed serve different roles. An ACE inhibitor like lisinopril is more about long-term remodeling and afterload reduction, but in the acute decompensated phase it can cause hypotension and may not provide the immediate relief needed. A beta-blocker like labetalol can blunt the heart’s pumping ability during an acute crisis and is generally avoided then. A loop diuretic like furosemide is indeed used to remove excess fluid, but nesiritide provides a more direct, rapid reduction in filling pressures and dyspnea in the acute setting.